unable to tolerate BCG treatments

14 hours 59 minutes ago #60982 by Alan
Replied by Alan on topic unable to tolerate BCG treatments
Void would be similar to urinating or peeing.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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23 hours 10 minutes ago #60981 by Jnani
Replied by Jnani on topic unable to tolerate BCG treatments
My heart is with you dear Alan.  Hope you hurt as little as possible!

Can you please reword 'voids' ?   (English is not my mother tongue language )

" The worst part for me was the next 1 or 2 voids after caths or scopes. "

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23 hours 18 minutes ago #60980 by Jnani
Replied by Jnani on topic unable to tolerate BCG treatments
Thank you dear joea73. 

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1 day 8 hours ago - 14 hours 58 minutes ago #60977 by Alan
Replied by Alan on topic unable to tolerate BCG treatments
I am NOT discounting the pain/discomfort in your catheter insertion with my following comments as everyone is different. Different size prostate, urethra, sensitivity etc. At the same time using a smaller cath if it works makes sense. The way I got through 12 of these plus 15+ scopes was to semi take my mind elsewhere (I know easier said than done). Also, it is such a short duration passing through the prostate area....maybe 15-20 seconds that I kept telling myself this is a lot better than losing my bladder. The worst part for me was the next 1 or 2 voids after caths or scopes. THAT is painful.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.
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1 day 8 hours ago #60976 by joea73
Replied by joea73 on topic unable to tolerate BCG treatments
Thank you for the updates and educating  all of us. Also congrats on coming through BCG treatment with less pain this time.

 Wikipedia says Lidocaine was discovered in 1945 and now it is included in WHO essential drug lists, also it is sold under different names.  Esracain site also says it is  Lidocaine Hydrochloride.  So, it is likely Esracain is a trade name and Lidocaine is generic name.

In term of catheter, 8 is really small.  They must have chosen it for you.  The nurse manual of  a Canadian hospital says #12 or #14 straight silicone catheter for females  #12 or #14 Tieman catheter for males.  But, European Association of Urology Nurse manual  (EAUN15) for BCG instilment says to the use smallest possible catheter. 

In regards to Chief nurse' comment on Estacaine (Lidocaine) on its impact to BCG efficacy, it may be true that no large scale studies are done for Lidocaine to compare the BCG efficacy with and without Lidocaine.  The  referenced  study in the recommendation of Society of Immunotherapy and Cancer, which Dr. Ashish Kamat - a world well known urologist of MD Andersons was involved in preparing the recommendation, was done  in 1996 in Germany.   The study tested 5 different lubricants, including Lidocaine  and identified that several components including Lidocaine hydrochloride were responsible for the inhibition of BCG viability.  Fluid recovered from the bladder after lubricant assisted catherization also showed a inhibitory effect.   I do not have access to the quantitative results.   

Accordingly,  European Association of Urology Nurse manual 2015 edition says  if possible choose a hydrophilic (self coated) catheter to reduce risk of discomfort, trauma and infection.  In terms of lubricant, for non-hydrophilic catheters, 10-15ml of lubricant with lidocaine and chlorhexidine should be used. This does not significantly reduce the efficacy of BCG therapy.   

Intravesical Administration of Therapeutic Medication for the Treatment of Bladder Cancer Jointly developed with the Society of Urologic Nurses and Associates (SUNA) manual by AUA says in Administrative Precautions states  Lidocaine Jelly (2%) may be used. Some urologists prefer it not to be used with BCG, Mitomycin, Gemcitabine, or Docetaxel.   Follow facilities guidelines regarding to use.  ** it does not say why some urologists do not want to use lidocaine.

It seems that European Nurse manual and American Nurse manual are not fully consistent in terms of the use of lidocaine.  

Also, it seems that the policy for using Lidocaine in BCG instilment is not fully consistent in what the urologic nurse manual says and Society of Immunotherapy and Cancer and Dr. Ashish Kamat is saying to bladder cancer patients.   I think this reflects to patients commentating that some hospitals use Lidocaine always and some don't.  It is noted that some patients who have lidocaine always are posing that BCG has worked well resulted in NED several years.  This tells that Lidocaine will not make all BCG bacteria inviable.  

 I am curious to know what is  MD Anderson nurse practice manual in administering BCG.


nurses.uroweb.org/wp-content/uploads/EAUN15-Guideline-Intravesical-instillation.pdf     page 34
www.auanet.org/guidelines/guidelines/intravesical-administration-of-therapeutic-medication  Sec XI. Administrative Precaution


best
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5 days 18 hours ago #60964 by Jnani
Replied by Jnani on topic unable to tolerate BCG treatments
Apparently, Esracain gel injected in my BCG treatment is identical with Lidocaine*. and the catheter is 8.
*Chief nurse said that no problem of compromising the BCG effectiveness (by using Ezracain) are known

In today's treatment, the nurse waited 5-10 minutes after injected the Esracain and prevented it from going out  ,and that seemed to have helped (less pain);   I also took 400mg Nurofen, 45 min. before we started so that might have affected too.

Good health to all of you!
 

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